CONFIDENTIAL
9 December 1992
Mr David Bates
District Inspector
PO Box 14124
Enderley
HAMILTON
Dear Mr Bates
re: Inquiry concerning Mr Malcolm Baker
As for other complaints I have:
a) Interviewed all those staff present/on duty on the day of the incident;
b) Where applicable, I have requested written statements;
c) Reviewed the nursing notes;
d) Reviewed the seclusion form and ten-minute checklists.
Mr Baker was admitted to the IPC unit, Tokonui Hospital on 7 July 1992 at 1145 hrs as a result of cancellation of his leave under Section 66 (4) and (5) of the Mental Health Act 1969. Mr Baker was brought to Tokonui by the Tauranga police and readmitted under Section 21 of the Mental Health Act.
Accompanying notes at the time stated that Mr Baker had been creating a nuisance up town Te Puke, found to be trespassing at night?, and driving his car around at night? Notes also indicated that Mr Baker had, on 1 July 1992, been recently discharged from the Tauranga Psychiatric Unit, Ward 17.
Dr Barnet, a general practitioner of Te Puke, had made a request on 3 July 1992, for the Psychiatric District Nurse to visit Mr Baker, as there was concern that his behaviour and mental state were deteriorating. The outcome of the PDN's visit on this occasion culminated in Dr Barnet requesting cancellation of Mr Baker's leave and a request for his re-admission. Mr Baker was summarily re-admitted to Tokonui Hospital on 6 July 1992.
On admission, the nursing notes state that Mr Baker presented with "slightly accelerated speech", "stated he could read the minds of animals", speech content was disjointed and he tended to move from subject to subject, flight of ideas", otherwise his mood was appropriate.
Mr Baker was generally described as cooperative to requests, but with some underlying hostility, therefore was placed in a single room to await doctor's interview.
On the D shift (1500 to 2330 hrs) Mr Baker remained cooperative though was described as flighty (unable to maintain a single theme of conversation, moved from topic to topic), and when spoken to by nursing staff his speech remained disjointed, making it difficult for nursing staff to comprehend, and Mr Baker was maintained in a single room for further observation.
On the A shift (2330 hrs to 8000 hrs) on 06.07.92, Mr Baker was reported to have slept through the night without problems, and to this point of his admission had received no medication.
On the morning of 07.07.92 the day of the incident the nursing notes state that Mr Baker was maintained in a single room still. However, the nursing notes also state that Mr Baker was loud, irritable, ? aggravating clients in the other single rooms. At this point, Mr Baker was offered oral medication, namely Chlorpromazine 100 mg orally (see Mr G Amer's statement attached), in order to try and allay his agitation. He however refused, and Chlorpromazine 100 mg by intramuscular injection as PRN medication was administered at 0800 hrs by Mr Amer.
After the administration of the injection of Chlorpromazine, Mr Baker appeared a lot quieter and more approachable and subsequently accepted oral medication when offered thereafter. Nursing notes indicate that Mr Baker spent the bulk of the day sleeping or lying on his matress.
On 08.07.92 Mr Baker was more settled and spent several hours out of his single room in the single room of one of two lounges watching TV.
On 09.07.92 Mr Baker spent all his time from 0900 to 1130 hrs in the television lounge; then subsequently transferred to the open side of the ward, as his mental state and behaviour had settled.
On 11.07.92 after spending five days in the IPC unit, Mr Baker was transferred to Ward 7, as his moods had settled and we felt that we could offer him nothing else in terms of treatment.
In general, I had a great deal of difficulty in investigating Mr Baker's complaints as none of the nursing staff on duty at the time can actually recollect Mr Baker or his admission. I therefore have been reliant upon what information has been available in the clinical notes and records only.
Please find attached a statement by Mr G Amer, the registered nurse who administered the intramuscular injection.
I am sure the nursing staff involved in this incident acted in a totally professional manner at all times, with Mr Baker's safety and best interests their paramount concern. If we can help you with any further information, please don't hesitate to ask.
Yours sincerely
(signed)
A G Thomson
CHARGE NURSE : IPC UNIT.
9 December 1992
Mr David Bates
District Inspector
PO Box 14124
Enderley
HAMILTON
Dear Mr Bates
re: Inquiry concerning Mr Malcolm Baker
As for other complaints I have:
a) Interviewed all those staff present/on duty on the day of the incident;
b) Where applicable, I have requested written statements;
c) Reviewed the nursing notes;
d) Reviewed the seclusion form and ten-minute checklists.
Mr Baker was admitted to the IPC unit, Tokonui Hospital on 7 July 1992 at 1145 hrs as a result of cancellation of his leave under Section 66 (4) and (5) of the Mental Health Act 1969. Mr Baker was brought to Tokonui by the Tauranga police and readmitted under Section 21 of the Mental Health Act.
Accompanying notes at the time stated that Mr Baker had been creating a nuisance up town Te Puke, found to be trespassing at night?, and driving his car around at night? Notes also indicated that Mr Baker had, on 1 July 1992, been recently discharged from the Tauranga Psychiatric Unit, Ward 17.
Dr Barnet, a general practitioner of Te Puke, had made a request on 3 July 1992, for the Psychiatric District Nurse to visit Mr Baker, as there was concern that his behaviour and mental state were deteriorating. The outcome of the PDN's visit on this occasion culminated in Dr Barnet requesting cancellation of Mr Baker's leave and a request for his re-admission. Mr Baker was summarily re-admitted to Tokonui Hospital on 6 July 1992.
On admission, the nursing notes state that Mr Baker presented with "slightly accelerated speech", "stated he could read the minds of animals", speech content was disjointed and he tended to move from subject to subject, flight of ideas", otherwise his mood was appropriate.
Mr Baker was generally described as cooperative to requests, but with some underlying hostility, therefore was placed in a single room to await doctor's interview.
On the D shift (1500 to 2330 hrs) Mr Baker remained cooperative though was described as flighty (unable to maintain a single theme of conversation, moved from topic to topic), and when spoken to by nursing staff his speech remained disjointed, making it difficult for nursing staff to comprehend, and Mr Baker was maintained in a single room for further observation.
On the A shift (2330 hrs to 8000 hrs) on 06.07.92, Mr Baker was reported to have slept through the night without problems, and to this point of his admission had received no medication.
On the morning of 07.07.92 the day of the incident the nursing notes state that Mr Baker was maintained in a single room still. However, the nursing notes also state that Mr Baker was loud, irritable, ? aggravating clients in the other single rooms. At this point, Mr Baker was offered oral medication, namely Chlorpromazine 100 mg orally (see Mr G Amer's statement attached), in order to try and allay his agitation. He however refused, and Chlorpromazine 100 mg by intramuscular injection as PRN medication was administered at 0800 hrs by Mr Amer.
After the administration of the injection of Chlorpromazine, Mr Baker appeared a lot quieter and more approachable and subsequently accepted oral medication when offered thereafter. Nursing notes indicate that Mr Baker spent the bulk of the day sleeping or lying on his matress.
On 08.07.92 Mr Baker was more settled and spent several hours out of his single room in the single room of one of two lounges watching TV.
On 09.07.92 Mr Baker spent all his time from 0900 to 1130 hrs in the television lounge; then subsequently transferred to the open side of the ward, as his mental state and behaviour had settled.
On 11.07.92 after spending five days in the IPC unit, Mr Baker was transferred to Ward 7, as his moods had settled and we felt that we could offer him nothing else in terms of treatment.
In general, I had a great deal of difficulty in investigating Mr Baker's complaints as none of the nursing staff on duty at the time can actually recollect Mr Baker or his admission. I therefore have been reliant upon what information has been available in the clinical notes and records only.
Please find attached a statement by Mr G Amer, the registered nurse who administered the intramuscular injection.
I am sure the nursing staff involved in this incident acted in a totally professional manner at all times, with Mr Baker's safety and best interests their paramount concern. If we can help you with any further information, please don't hesitate to ask.
Yours sincerely
(signed)
A G Thomson
CHARGE NURSE : IPC UNIT.